Friday, 12 May 2017

SYNDROMES IN PSYCHIATRY


Wernicke’s encephalopathy
An acute reaction to severe thiamine deficiency mostly d/t chronic alcohol use.
C/b ocular signs (nystagmus & external ophthalmoplagia)
Higher mental function disturbance(disorientation, confusion, recent memory disturbances)
Apathy & ataxia. Peripheral neuropathy & malnutrition may be co-existent.

Korsakoff’s psychosis
Also d/t severe thiamine deficiency d/t chronic alcohol use.
C/b amnestic syndrome with gross memory disturbances, Confabulation. Insight often impaired.

Marchiafava-Bignami syndrome
A rare disorder most probably d/t alcohol-related nutritional deficiency.
C/b disorientation, personality & intellectual deterioration, hallucinations, epilepsy, dysarthria,
ataxia & spastic limb paralysis.

Holiday Heart
Atrial or ventricular arrhythmias, especially paroxysmal tachycardia, after drinking a binge of alcohol
in individuals showing no other evidence of heart disease.


Hemp insanity (cannabis psychosis)
Asso with cannabis.
Acute schizophreniform disorder with disorientation & confusion. Good prognosis.

Amotivational syndrome
Lethargy, apathy, loss of interest, anergia, reduced drive & lack of ambition d/t chronic cannabis use.

Van Gogh syndrome
Dramatic self-mutilation occurring in schizophrenia.

Pfropf schizophrenia
A syndrome of schizophrenia occurring in presence of mental retardation.

Oneiroid schizophrenia
A subtype of schizophrenia with acute onset, clouding of consciousness, disorientation, dream-like
states & perceptual disturbances with rapid shifting.

Alice in Wonderland syndrome
Perceptual distortion of shape, size, colour& reciprocal position of objects. seen with schizophrenia,
Migraine

PAD syndrome
Phobic-Anxiety-Depersonalization syndrome.
Commoner in women 20-40 years.
C/b diffuse anxiety, multiple phobias, panic attacks, depersonalization, derealization & depressive Features.
Othello syndrome (conjugal paranoia)
A psychosis in which the content of delusions is predominantly jealousy (infidelity) involving spouse.

Clerambault’s syndrome (erotomania)
A psychosis in which the content of delusions is erotic.
Most often in women with erotic conviction that a person with higher status is in love with the
patient.

Kadinsky-Clerambault’s syndrome
A syndrome of mental automatism

Folie a deux
Induced delusional disorder c/b sharing of delusions b/w 2 persons.
So is folie a trios, folie a quatre, folie a famille

Capgras’ syndrome (delusion of doubles)
C/b delusional conviction that other persons in environment are not their real selves but are their
own doubles.
There are 4 types
1. Typical Capgras’ syndrome(illusion des sosies)- pt sees a familiar person as a stranger who is
imposing as the familiar person.
2. Illusion de Fregoli pt falsely identifies strangers as familiar persons.
3. Syndrome of subjective doubles pt’s own self is perceived as being replaced by a double.
4. Intermetamorphosis pt’s misidentification is complete including both external appearance &
personality.

Fregoli’s phenomenon
Delusion that a persecutor is taking on a variety of faces like an actor.

Cotard’s syndrome
Delusion that one has lost everything- possessions, strength & even bodily organs such as heart.
Seen in severe depression where pt has extreme nihilistic delusion (e.g. may think that his bowels
are rotting and he will never pass stools again)

Ganser’s syndrome (hysterical pseudodementia)
Commonly found in prison inmates.
C/b vorbeireden- approximate answers- person understands nature of questions but answers wrong.

La-Belle-Indifference
Lack of concern towards symptoms despite apparent severity of disability produces.
Seen in patients with conversion & dissociation disorder (hysteria).

Briquet’s syndrome (Somatisation disorder)
A chronic or recurrent illness with either a dramatic or complicated medical history.
A pt with at least 25 unexplained medical symptoms for a diagnosis or with 20-25 unexplained
symptoms for a probable diagnosis.

Munchausen syndrome (Factitious disorder, Polysurgis, Professional patients, Hospital hoboes,
Hospital addiction)
Pt repeatedly simulates or fakes diseases for sole purpose of obtaining medical attention.

Munchausen syndrome by proxy
Pt intentionally produces physical signs & symptoms in another person who is under pt’s care.

Charles bonnet syndrome phantom visual images

Ekbom syndrome (Restless Legs syndrome)
Pt experiences extremely uncomfortable feeling in leg muscles during walking.
Asso with insomnia.

Gelineu’s syndrome
Narcolepsy. Associated with hypersomnia.

Pickwickian syndrome
Sleep apnea commoner in elderly & obese persons, associated with hypersomnia.

Kleine-Levin syndrome
C/b hypersomnia, hyperphagia, hypersexuality


Clumsy Child syndrome (Motor dyspraxia, Motor skills disorder, Developmental coordination
disorder)
C/b poor coordination in daily activities of life.

Idiot Savant syndrome
Pervasive impairment of functions but certain islets of precocity or splinter functions may remain.

Heller’s syndrome (Disintegrative psychosis)
A type of childhood psychosis with age of onset 3-5 years.
C/b rapid downhill course leading to deterioration & development of neurological deficits.

Asperger’s syndrome
Predominantly in boys.
Less severe form of pervasive developmental disorder
Autism without significant delay in language & cognitive development.
schizoid personality
pedantic speech
preoccupation with obscure facts

Rett’s syndrome
Occurs in girls.
After an apparently normal early development & normal head circumference at birth, there is
deceleration of head growth b/w age of 5-30 months.
Loss of purposive hand movements & acquired fine motor manipulative skills with subsequent
development of stereotyped hand movements.
Strauss syndrome
Attention deficit hyperkinetic disorder, Minimal brain dysfunction, Organic drivenness.

Gilles de la Tourette’s syndrome
C/b multiple motor tics
Multiple vocal tics
Duration of >1 year

Kanner syndrome
Failure to develop attachment with a parenteral figure & pre-occupation with inanimate objects.

Culture-Bound Syndromes are as follows

Dhat syndrome
A culture-bound syndrome prevalent in Indian subcontinent.
C/b complaint of passage of ‘dhat’ in urine.
Multiple somatic symptoms.
Asthenia
May be anxiety, depression or sexual dysfunction associated.

Koro
Prevalent in Asia including India.
Affected male pt believes that his penis is shrinking & may disappear into his abdominal wall & he
may die.
Females affected infrequently, believing that their breasts & vulva are shrinking.


Amok
Prevalent in South-East Asia.
C/b sudden, unprovoked episode of rage in which affected person runs about & indiscriminately
injures or kills any person who in encountered on the way.

Latah (Startle reaction)
Prevalent in South-East Asia & Japan.
More in women, c/b automatic obedience, echolalia & echopraxia.

Windigo (Wihtigo)
Prevalent in native American Indians.
Pt believes that he has been transformed into a wihtigo, a cannibal monster, occurring especially
during times of starvation.

Shinkeishitsu
A defense syndrome, mainly of anxiety but with obsessive features occurring in young Japanese
thrown into a modern industrial society for which they are not equipped. They feel inadequate, lost
& unloved.

Susto
Occurs in Latin America.
Pt believes that his body is entered by a magical substance & that he is altered. It takes on a
delusional quality.


Piblokto (Arctic Hysteria)
Occurs in Askimos.
Often female, who screams & tears off her clothes, throw herself on ice in extremely cold conditions.
She may imitate the cry of a bird or an animal.
The episode lasting for 1-2 hours, f/b amnesia of events.

COUVADE's Syndrome: Seen in husbands of pregnant women. the prospective father develops
symptoms similar to pregnancy & symptoms r relieved by delivery.

STOLKHOLM Syndrome: Identification with the aggressor usually seen in kidnap victims who try to
protect their kidnappers.

JACTATIO CAPITIS NOCTURNA: Nocturnal head banging

DEJA VU: Recognition of events that are in fact new

JAMAIS VU: Opposite of Deja vu where patient fails to recognise events that have occured before

SYNDROMES ASSOCIATED WITH TREATMENT OF PSYCHIATRIC CONDITIONS

SUNDOWNER SYNDROME: Drowziness, confusion, ataxia, accidental falls, in older patients who are
over sedated & in old patients with Dementia who react adversly to even small dose of psychoactive
drug. It also occurs in demented patients when external stimuli such as light & interpersonal
orienting cues are diminishd. Most commonly occurs as result of Rx with BZD's

RABBIT SYNDROME: Extra pyramidal side effect of chronic anti-psychotic treatment. Rapid & regular
perioral tremors like chewing movements, tongue & other body parts not involved.

NEUROLEPT MALIGNANT SYNDROME: EPS. Hyperthermia, severe muscular rigidity, autonomic
instability, changes in mental status, increased CPK, liver transaminase, leucocyte function,
myoglobinuria

ANTI-CHOLINERGIC SYNDROME: Phenothiazines, TCAD's, Anti-Parkinson drugs all have anticholinergic
properties, when these r administered in combination patient shows evidence of organic
brain syndrome including difficulty in concentration, impaired short term memory, disorientation,
dry SKIN due to inhibition of sweating, more noticable at night.

SSRI DISCONTINUATION SYNDROME: Abrupt discontinuation of SSRI causes dizziness, nausea,
vomiting, lethargy, flu-like symptoms, sensory & sleep disturbances, irritability, anxiety, crying spells.
SSRI's with short half life like Paroxetine & Sertraline more likely causes
SEROTONIN SYNDROME: Abdominal pain, Diarrhoea, excessive sweating, fever, tachycardia,
hypertension, alteration of mental status including delirium, myoclonus, increased motor activity,
mood changes Severe cases may show hyperpyrexia, shock & death. It is due to overactivity of
serotoninergic receptors by excess of serotonin due to combination of MAO, SSRI or TCAD.

DA COSTA's SYNDROME: Irritable heart syndrome. has as many as 20 different names. Was seen
first in soldiers of civil war. Chief complaints are all related to cardiac Pathology in which the subject
has fear of a heart ailment which may progress to hypochondriasis & sometimes to circulatory
neurasthenia


Sunday, 19 February 2017

One liners

MCC of intracranial metastasis-Ca lung
MCC of hepatic metastasis - Bronchogenic carcinoma
MCC of hepatic mets from GIT – Colonic ca
MCC of Intrauterine Growth retardation-C/c pyelonephritis?
MCC of HTN in children-A/c Glomerulonephritis
MC complication of CSOM-Temporal lobe abscess
MC ovarian tumour in pregnancy-Teratoma/Dermoid cyst
MC joint involved in Osteo Arthritis-Knee joint
MCC of interstitial/atypical pneumonia- Mycoplasma
MC Glycogen storage disease-Gaucher’s disease
MC porphyria-Porphyria cutanea tarda.
MC cause of childhood nephrotic syndrom-Minimal change disease
MC cause of adult nephrotic syndrome- Membranous glomerulonephritis.
MC cancer-Lung cancer
MC cancer in females-Breast cancer
MC cause of maternal deaths-Obstetric hemorrhage(PPH)
MC cause of Blindness in India-Catarac

High yield-Most common

Most common cause of morbidity and mortality in patient undergoing major vasculr surgery is- CARDIAC COMPLICATIONS
Most common cause of sporadic viral encephalitis is-HSV-1
Most common cause of viral meningitis or aseptic meningitis is- ENTERO VIRUS
MOST COMMON CAUSE OF EPIDEMIC OF VIRAL MENINGITIS is- ARBOVIRUSES
Most common cause of neonatal sepsis in hospitals in India is- KLEBSIELLA
The Mc abnormal opthalmoscopic findings on fundoscopY in AIDS pt is- COTTON WOOL SPOTS
Mc severe ocular complication of AIDS is- CMV RETINITIS
Mc cause of NOSOCOMIAL inf is- STAPH. AUREUS.
Mc cause of TRAVELLER’S DIARROHEA is -ENTEROTOXIGENIC E.COLI
Mc sinusitis in children is- ETHMOIDAL.
Mc sinusitis in adults is -MAXILLARY.
Mc Site of ca tongue is MIDDLE OF LATERAL BORDER or VENTRAL ASPECT of tongue.
Mc MALIGNANT TU of adult males in india-ORAL CANCER
Mc MALIGNANT cancer of adult males in WORLD IS-LUNG CA
Mc MALIGNANT cancer of female in india is – CA CERVIX
Mc MALIGNANT cancer of female in WORLD IS -CA BREAST
Mc organism for ACUTE OTITIS MEDIA IN ANY AGE GROUP ID- Strptococcus PNEUMONIAE>H.INFLUENZA>M.CATARRHALIS.
Most common indication for splenectomy is -Splenic trauma.
Most common cause of cholangitis is -CBD stone
Most common cause of pancreatitis is- Gall stone
Most common cause of pancreatic pseudocyst is -Pancreatitis
Mc cause of myeloproliferative disorder –Polycythemia vera
Mc cause of stroke — Thrombosis >Embolism
Mc of RBC enzyme def. — G6PD def.
Mc variant of HL in INDIA — Mixed cellulatity
Mc urinary fistula-VESICOVAGINAL
Mc cause of VESICOVAGINAL FISTULA in india- Obstructed labour
Mc side effect of IUCD- BLEEDING   2ND MC side effect is PAIN
Mc site of ENDOMETRIOSIS is Ovary   2nd MC site is POUCH OF DOUGLAS
Mc cause of Post menopausal bleeding in DEVELOPED COUNTRIES is -CA ENDOMETRIUM.
Mc cause of post menopausal bleeding in DEVELOPING COUNTRIES(INDIA) is- CA CERVIX
Mc site of genital TB-FALLOPIAN TUBE.
Mc symptom of genital TB is- INFERTILITY
Most common lobe involved in BPH is- MEDIAN.
Mc long term complication of TURP IS- RETROGRADE EJACULATION

Entrapment Syndrome -Nerve involved

Entrapment Syndrome -Nerve involved
Carpal tunnel syndrome -Median nerve (at wrist) (Most Common)
Pronator syndrome -Median nerve (proximally compressed beneath - ligament of struthers, bicipital aponeurosis or origins of pronator teres or flexor digitorum superficialis)
Cubital tunnel syndrome -Ulnar nerve (between two heads of flexor carpi ulnaris)
Guyon's canal syndrome- Ulnar nerve (at wrist)
Thoracic outlet syndrome
Lower trunk of brachial plexus, (C8 and T1) and subclavian vessels (between clavicle and first rib)
Piriformis syndrome -Scaitic nerve
Meralgia paraesthetica -Lateral cutaneous nerve of thigh
Cheralgia paraesthetica -superficial radial nerve
Tarsal tunnel syndrome -Posterior tibial nerve (behind and below medial malleolus) 
Morton's metatarsalgia -lnterdigital nerve compression (usually of 3rd, 4th toe)

Microarray

MICROARRAY Analysis:
__________________________
RNA is prepared from cells, reverse transcribed to cDNA, and labelled with fluorescent dyes .
Green dye for normal and red dye is for cancer cells.
The fluorescent probes are mixed and hybridized to a cDNA array.
Each spot on the array is an oligonucleotide (or cDNA fragment) that represents a different gene.
Image is captured by fluorescence camera where:
a) Red spot indicates higher expression in tumor cells.
b) Green spot indicates lower expression in tumor cells.
c) Yellow spot indicates equal expression level in both normal and tumor samples

Flow cytometry markers :

Flow cytometry markers :
CD1a, S-100, CD-207(Langherin)- Langerhan cell histiocytosis
CD 2 3 4 5 7 8- T-cell markers,CD3 is pan T cell marker
CD10 (aka CALLA antigen) : Early pre B marker,immature B cell marker
CD 11c, 25, 103, 123 : Hairy cell lukemia (CD 123 Most specific)
CD 13,33,117, MPO: Myeloid series marker-AML
CD 14,64: Monocyte marker (AML-M4 M5)
CD 15 : RS cell,Neutrophils
CD 15,30 : RS Cell
CD 16,56: NK Cell
CD 19,20,21,22 : B Cell markers, CD 19 is pan B cell marker
CD 23+,CD 5+ : CLL/SLL
CD 23-,CD 5+ : Mantle cell lymphoma
CD 30(only) aka Ki-antigen : Anaplastic Large cell lymphoma
CD 31: Endothelial cell marker (positive in angiosarcomas)
CD 34: Stem cell (also positive in angiosarcomas)
CD 41,61: Megakaryocyte,platelet marker,positive in AML-M7
CD 45 : On all leukocytes(except RS cell)
CD 45 RO: Memory cell
CD 45RA/RB: Naive B/T Cell
CD 55(DAF), CD 59(MIRL) : Absent in PNH
CD 68,S-100+ :Histiocyte marker(+ in malignant fibrous histiocytosis)
CD 95/FAS ligand: apoptosis marker (extrinsic pathway)
CD 99/MIC-2 : Ewings sarcoma
CD 103: Hairy cell
CD 117 :GIST,Mastocytosis,AML (117 is present on mast cells also)
CD 123: New antibody in Hairy cell leukemia
CD 133:Glioma
CD 207(Langherin): LCH
CD 235(Glycophorin): AML-M6

RNA

Credits: Dr. Rebecca James, Biochemistry
####Facts RNA Editing####
● It is an exception to Central Dogma of Molecular Biology.
i.e., DNA ---- RNA ------ Protein.
● Apo B gene codes for Apo B Protein.
● In Intestine the gene codes apo B48, whereas the same gene to apo B 100 in liver.
● In liver ..... apoB gene .. apo B 100 Protein.
● In Intestine
Apo B gene to Apo B RNA.
● In 48th codon of apo B mRNA there is CAA.
● This C in CAA undergo editing, i.e., mRNA editing
i.e., Deamination of C to U.
● Now at 48th position CAA is changed to UAA.
● UAA is a stop codon.
● So instead of apo B100, here the same gene produces apo B48.
● This is an example of RNA editing.